Inspection on 10/02/09 for Caritate Nursing Home

This inspection was carried out on 10th February 2009.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Caritate Nursing Home 18/10/07

Caritate Nursing Home 15/02/07

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Caritate Nursing Home Laninval House Treningle Hill Bodmin Cornwall PL30 5JU     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Caritate Nursing Home Treningle Hill Laninval House Bodmin Cornwall PL30 5JU 0120875628 0120874921 manager.laninval@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Caritate Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 24 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 24 Three named service users may be accommodated who require care and accommodation by reason of old age, not falling into any other category. Up to 15 service users may be over 65 years of age who require nursing care and accommodation by reason of old age or physical disability. Date of last inspection Brief description of the care home Caritate was previously known as Laninval House and is situated approximately one mile from the centre of Bodmin and is set in 16 acres of grounds. It is an older, privately owned property with an added extension. It offers nursing care to mainly younger adults with disabilities and is viewed as a home for life, if this is the wish of the person concerned. A number of residents are dependent on a wheelchair for mobility. The ground floor of the home provides mainly communal space and is divided into several separate and distinct areas. There are also two sun lounges where smoking is permitted. Bedroom accommodation predominantly comprises of single Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home rooms. Stairs and a shaft lift provide access to all the floors and a range of disability equipment is available to assist residents. Externally there are very large grounds, much of which is level and accessible by wheelchair. There is a car parking area at the front of the house.Qualified Nurses and Care Assistants provide care within a relaxed and friendly atmosphere.Information about the home is available in the form of a residents’ guide, which can be supplied to enquirers on request. A copy of most recent inspection report is available in the home. Fees range from 560 to over 750 pounds per week. Additional charges are made in respect of private healthcare provision, hairdressing and personal items such as newspapers, confectionary and toiletries. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: We visited Caritate Nursing Home on the 10th February 2009 and spent approximately 7.5 hours at the home. This was a key inspection and an unannounced visit. The purpose of the inspection was to ensure that the needs of the people using the service are properly met, in accordance with good care practices and the laws regulating care homes. The focus was on ensuring that placements in the home result in good outcomes for people. It was also to gain an update on the progress with requirements identified in the last inspection report dated 18th October 2007. The CSCI Annual Quality Assurance Assessment (AQAA) document completed by the provider has also been considered to support this inspection. All of the key standards were inspected. On the day of inspection 21 people were living in the home, 1 of these was receiving Care Homes for Adults (18-65 years) Page 6 of 29 respite care. The methods used to undertake the inspection were to meet with a number of residents, staff and the registered provider to gain their views on the service. Records, policies and procedures were examined and the inspector toured the building. This report summarises the findings of this inspection. The registered providers have continued to make significant improvements to the premises and the care provision for people using the service. Residents expressed satisfaction with the care and services provided at the home. Overall the home is providing a good quality of care to the residents placed there. What the care home does well: What has improved since the last inspection? The chef will be starting the process of reviewing the Summer menu with the residents. Further re-decoration, refurbishment and internal building work has taken place to improve the environment: designed & decorated & refurbished new nurse station; tiled Residents smoking lounge floor; fire Risk assessment smoke seals to bedroom doors fitted; room 16 refreshed decoration and renewed skirting boards; room 15 replaced carpet with vinyl floor; main Lounge created from two rooms into one, decorated & refurbished; room 3 remodelled, decorated & refurbished; top mezzanine corridor Care Homes for Adults (18-65 years) Page 8 of 29 walls repaired, decorated & refurbished; main house cold water tank lagged; pinch point redesigned, built, decorated & refurbished; flat roof room 6 replaced; flat roof lift shaft replaced; flat roof bathroom replaced; new fire alarm system installed; new nurse call bell system installed; rooms 2, 5, 8, 19, 10, 11, decorated, re-carpeted & refurbished; front door new ramp & rails designed and built; library (second lounge) designed, refurbished and decorated; kitchen decorated; new beds have been purchased along with new bed linen and towels for every room. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessment documentation and care plans are received from external agencies. All prospective residents are assessed by a competent person from the home prior to admission, with records maintained. The people who are thinking about a move to Caritate are provided with good information to help inform them about their choice of home. Evidence: The files of three people that live at the home were inspected and these contained relevant and appropriate assessment documentation completed by the registered provider or a nurse from the home. All residents and prospective residents are provided with a copy of the homes Service User Guide. The Statement of Purpose and Service User Guide was seen to be up-todate and displayed in the entrance to the home. The registered provider said that alternative formats could be provided if needed. Care Homes for Adults (18-65 years) Page 11 of 29 Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of residents, who are involved to the best of their capabilities in decision-making and self-determination. Evidence: The registered provider demonstrated a detailed understanding of the complex range of needs that are presented by residents and the records inspected detailed how the relevant support is provided. Monika Peach, the registered provider, is involved daily with the running of the home, she is available to residents and their families at all times. She is involved with the multidiciplinairy team and attends all meetings concerning residents. Residents each have an individual care plan, which sets out the goals of their placements in the home so that they maintain and develop their independence and are able to enjoy a good quality of life in a homely, community setting. They are encouraged to make decisions for themselves about things that are important to them, such as how to spend their money and what to wear. They are supported to take managed risks so that they develop their confidence and skills. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: There is insufficient evidence that care plans are regularly reviewed with, where possible, the involvement of the person concerned. The format of the assessments and care plans means that the understanding of them may be open to interpretation. The need for the care plans to provide clear direction as to the interventions needed to meet care needs was discussed with the registered provider. Policies and procedures have been put in place to safeguard the people using the service. It is clear that staff care for residents and risks are managed though their knowledge and skills. Written risk assessments are in place. Any form of restraint such as bed rails should be risk assessed; consent should also be obtained and the decision should include all relevant people, for example relative, physiotherapist and GP. The people using the service were seen to make decisions on how they spend their time and they decide when to get up and go to bed and so on. One resident was assisted to attend a hospital appointment. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of social and recreational opportunity is available in keeping with known preferences and capabilities. Residents engage with the local community, and all have appropriate contact with people important to them. Residents rights and capacity as adults is recognised. A balanced diet is provided. Evidence: Activities take place in the home, entertainers visit and the residents go out on trips and into town and so on. Residents are involved in planning of daily life and activities. Social activities in the home include: painting sessions with local artist, games, music sessions, baking; the involvement of outside agents such as hairdresser, aromatherapy, theatre groups, musians, and church services. There is a Weekly shopping trip using the minibus, and weekly outings: ice-rink, beaches, zoo, fishing. Residents are encouraged to join clubs. Residents are involved in a range of Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: appropriate leisure/work activities and maintain contact with people important to them. The registered provider and staff have no involvement with the management of individuals finances. The chef said she will shortly be reviewing the Summer menu with the residents. A record of food provided is written in the kitchen diary. There is a choice available at every meal, and either the chef or another member of staff will ask residents daily for their choices. The menu is displayed in the dining room. The kitchen has been refurbished with stainless steel fittings, and was seen to be clean and organised at the time of the inspection. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal support is given to residents according to their needs, ensuring their individual preference is respected. Residents have access to health care services as necessary to ensure their physical and emotional needs are met. There is a suitable system in place for dealing with residents medicines. Evidence: The registered provider and staff said they ensure that appropriate personal support, care and encouragement are provided in such a way as to respect residents privacy and dignity. The care records, observation, and discussion with the registered provider and staff show that the residents waking day is flexible. The residents are free to determine their own lifestyle. Special equipment including special wheelchairs is provided as needed and the home employs a physiotherapist. All residents are registered with a GP and specialist health care workers are consulted as necessary, for example speech therapists, occupational Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: therapists, dentists, and doctors. A key worker system is used, meaning that residents know they each have a member of staff responsible for overseeing their care needs. A monitored dose system is in use. The medication fridge temperature check is done daily. Medication store cabinet temperature check is done daily. Medicines received are entered on the charts and the disposal records are satisfactory. There were no gaps in the administration records. Any hand written instructions on the medicine charts should be witnessed and signed by two people. Medicines are stored safely and securely. The system for managing controlled drugs is appropriate. The registered provider has included appropriate medication training for staff. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a suitable complaints procedure. Residents were seen to interact with staff in a relaxed manner. The registered manager has a clear understanding of Adult Protection issues and procedures that will protect residents from abuse. Evidence: The people that live at Caritate are enabled to maintain existing contacts with relatives and friends, and external agencies. The homes complaints procedure is available to residents in the Service User Guide. The home has an appropriate policy and procedure regarding complaints and concerns. The Commission for Social Care Inspection has not received any complaints since the last inspection. The registered provider and about 50 of staff have attended multi-agency training on protecting vulnerable adults from abuse. The home has copies of the local authority procedures for safeguarding vulnerable adults in addition to its own internal procedures. All clients have some access to resources outside of the home so they are not isolated there. The registered provider said she would continue with their commitment to arranging safeguarding training for all staff. There is no money held on behalf of residents. The registered provider does not act as appointee for any resident. Care Homes for Adults (18-65 years) Page 19 of 29 Care Homes for Adults (18-65 years) Page 20 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered providers have improved the environment for residents and they are determined to offer accommodation that exceeds the minimum standards. The home is clean and free from offensive odours making it a pleasant place to live in. Evidence: The home provides a warm, comfortable, homely environment. It is clean, well furbished and free from odours. The providers have made significant improvements to the premises to make sure it is watertight and to provide quality accommodation for residents. They have an extensive refurbishment plan that is continuing and progressing very well. They say they intend to exceed the National Minimum Standards and the work to date proves their intentions. The home provides plentiful communal space and pleasant bedrooms, which are decorated with the involvement of the person living there. Work and improvements carried out to date include: designed & decorated & refurbished new nurse station; tiled Residents smoking lounge floor; fire Risk assessment smoke seals to bedroom doors fitted; room 16 refreshed decoration and renewed skirting boards; room 15 replaced carpet with vinyl floor; main Lounge created from two rooms into one, decorated & refurbished; room 3 remodelled, Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: decorated & refurbished; top mezzanine corridor walls repaired, decorated & refurbished; main house cold water tank lagged; narrow area on the first floor known as the pinch point redesigned, built, decorated & refurbished; flat roof room 6 replaced; flat roof lift shaft replaced; flat roof bathroom replaced; new fire alarm system installed; new nurse call bell system installed; rooms 2, 5, 8, 19, 10, 11, decorated, re-carpeted & refurbished; front door new ramp & rails designed and built; library (second lounge) designed, refurbished and decorated; kitchen decorated; new beds have been purchased along with new bed linen and towels for every room. There is suitable lighting and ventilation. The registered provider is in the process of covering radiators to prevent possible injury to residents. Residents rooms are personalised with their own possessions. There are two sun lounges dedicated for residents who wish to smoke. Residents can easily access the large garden, which is well maintained and equipped with garden furniture. Appropriate washing machines and driers have been installed in the laundry. Protective clothing and suitable hand-washing facilities are provided for infection control purposes. The home is clean and hygienic and residents are satisfied with the standards maintained by the present providers. Care Homes for Adults (18-65 years) Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staff team is effective in supporting service users. Recruitment practice protects the rights and interests of the people that stay there. Staff complete appropriate training to meet the needs of service users. Evidence: Many of the care staff have worked at the home for a considerable time. Staff were seen to interact well with residents and spend time talking with them. 46 of care staff have achieved at least NVQ level 2 and a further 27 are working towards the qualification. The duty rota showed that a qualified nurse is on duty at all times. There is usually 1 nurse plus 5 carers on in the mornings, 1 4 in the afternoons, and 1 1 at night. There is sometimes an additional carer at peak periods. The providers use a recruitment system with an equal opportunities policy. Three staff files were inspected and these contained the records required by legislation, including job description. The registered provider confirmed that contracts of employment are given to staff. There were interview records, induction records, and health declarations on file. All the three files had a photograph of the employee. Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: There is a structured induction programme with a checklist to be signed. New staff undertake an National Training Organisation induction programme. The registered provider confirmed that all staff receive a copy of the General Social Care Council handbook. A physiotherapist is responsible for moving and handling training. Fire training has been done. A training matrix identifies training completed, and where training needs are evident. A sample of staff supervision records was seen at the time of the inspection and discussion occurred about how best to record this was happening regularly. Care Homes for Adults (18-65 years) Page 24 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered providers are competent and experienced and residents benefit from a well run home. The home is run in the best interest of the residents and they benefit further when the Quality Assurance systems are in place. The registered providers promote the safety of the residents however fire safety checks have not been kept up to date and some other checks need to be undertaken to ensure the health, safety and welfare of residents and visitors to the home. Evidence: Mr Stuart Peach is an experienced Management Consultant with over 20 years experience. Stuart is the Managing Director and Secretary of Caritate Ltd and manages the administration of the home. Mrs Monika Peach is a Registered General Nurse and has a Masters Degree in Health and Nursing Studies. Monika has over 30 years of nursing experience and is the Operations Director of Caritate Ltd. In the preceding 18 years of her profession she specialised in managing Nursing Homes as Home Manager, Area Manager and as Regional Manager/Operations Manager for big nursing home companies. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The registered provider intends to utilise the CSCI Annual Quality Assurance Assessment document as part of the homes quality assurance system. She said that informal audits will take place but there are no written records yet. The registered provider speaks with residents every day. There are environmental risk assessments for the home. The fire risk assessment has also been completed and fire drills take place regularly. Hazardous substances are stored safely. The fire safety checks were up to date. Policies and procedures were reviewed in 2008, and staff are asked to sign when they have read new or updated copies. Copies of annual safety checks (e.g. electrical system certificate) were available. There are copies of written risk assessments in respect of the homes general environment and fire safety and records of fire safety equipment checks and alarm tests were upto-date. There is appropriate insurance in place. Legionella testing should be be done. Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 6 The registered provider should ensure the regular review of care plans with, where possible, the involvement of the resident or their representative. The registered provider should ensure that where a care need is identified, the care plan provides clear direction to staff as to the intervention needed. The registered provider should ensure multi-disciplinary involvement when consent may be an issue (e.g. use of bed rails). The registered provider should ensure that two signatures are evident where staff have to make written entries on the MAR sheets. The registered provider should ascertain the views of the people that use the service and other stakeholders, publishing a summary of the findings and any action taken as a result. The registered provider should ensure annual testing of the water system for legionella is done. 2 6 3 9 4 20 5 39 6 42 Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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